8.4 CAA's responsibilities are focused on air safety.
Any involvement in passenger health or comfort arises only indirectly
as a consequence of safety, particularly in relation to emergency
evacuation from aircraft (p 1). CAA does not address long-term
health effects from flying (p 16) even in relation to flight crew
(p 1, Q 60).

8.5 HSE has general oversight of employees' health
and safety but, as noted in paragraph 3.21, commercial aircraft
are largely exempt from the provisions of UK health and safety
at work legislation. As regards the remaining relevant provisions,
HSE avoids overlapping responsibilities with CAA under a memorandum
of understanding, leaving the lead essentially with CAA.

8.6 On the international scene, JAA also stated that
their primary concern was with safety and that their position
on flight crew and passenger health was the same as CAA's (p 130).
However, JAA recognised that passenger health might become more
important in the future development of aviation. Indeed, they
have set up a working group to examine this - although, reflecting
JAA's general remit, the approach will continue to be strongly
linked to air safety (p 130).

8.11 In the effective national (and international)
policy vacuum on passenger health and comfort noted above, aircraft
manufacturers and airlines have accepted responsibility. Both
directly and through airline representative bodies, they professed
high ideals (pp 99, 104, 107, 110, 224 & 229). We were surprised,
however, at the degree of complacency amongst them.

8.12 AUC and the airlines are understandably concerned
not to scare the travelling public (pp 57, 99 & 104). As British
Airways stated, "we want to be absolutely honest with the
customers and potential customers, but we do not want to frighten
them" (Q 323). But such honesty requires an acknowledgement
of risk and uncertainty where that exists. The representative
of ATA told us that, while USA-based airlines often had a small
general health brief in in-flight publications, it did not include
DVT - because they could "not say definitively that there
is a direct causal relationship between air travel and DVT and,
as such, we do not wish to frighten our passengers unnecessarily"
(Q 302).

8.13 On behalf of British airlines, BATA did not
consider that there were any significant health issues about which
they should have serious concerns currently (p104); ATA (p 110)
had similar views. British Airways felt that much of the public
concern about health in the cabin environment was only anecdotal
(Q 310)[102].
The airline Emirates stated that there was no evidence to suggest
that the cabin environment was unhealthy or adversely affected
passengers or crew (p 229).

8.14 Among the manufacturers, Boeing felt the need
for more research into the possible causes of flight crew and
passenger symptoms and complaints (p 204). Airbus Industrie said
they were "ready to consider improvements to aircraft design
if there is a clear link with passenger or crew health" (p
165).

8.15 We had expected AUC (set up by CAA to represent
the interests of air passengers to regulatory authorities and
service providers) to help get attention focused on these matters.
However, it had no human or material resources to commission research
and was essentially reactive, although its representatives said
they would lobby for regulatory change if they thought it was
necessary (p 57, QQ 157-169).

8.25 Additionally, much of the evidence given to
us about the health effects of flying is based either on anecdote,
which is scientifically unreliable, or on extrapolation from studies
carried out in ground environments, notably in relation to DVT
(see paragraphs 6.13-6.14) which is also scientifically unsound.
As discussed in previous Chapters, the cabin environment at cruising
altitude is very different from any ground environment, not only
in many individual respects but also, and particularly, in the
potential for interplay between those effects.

8.27 The absence of a broad and detailed knowledge
base means that neither the general public, nor their professional
health advisers, can easily obtain reliable high-quality information,
particularly about unusual sets of circumstances. The implications
of this for individuals' assessment of any potential health risks
from the aircraft cabin environment about which they may be concerned
are discussed further in the next section.

8.28 Given these gaps in the knowledge base, we were
pleased to hear about the DETR/DoH research proposal noted in
paragraph 8.3. Drawing on the points made throughout this Report,
our suggestions for the topics needing to be covered are summarised
in paragraph 9.3.

8.30 Neither publication would be of any assistance
to someone not in robust health seeking information on which to
base a decision on whether to fly - or even whether they needed
to seek professional advice. The question is how people are to
judge this for themselves without carefully framed guidance -
such as the risk categories we have proposed in relation to DVT
(see paragraph 0).

8.31 AsMA drew our attention (p 198) to the leaflet
Useful Tips for Airline Travel that they publish with the
ATA. This usefully outlines the main features of the cabin environment
and contains helpful advice. While it does not refer to DVT explicitly,
it does encourage movement "to prevent leg compression and
blood pooling" and notes that "one good exercise is
to flex and extend the ankle joint every 20-30 minutes".
It advises intending passengers to delay their trip if they are
not well or have a contagious disease and to consult their physician
if they have a history of blood clotting disorders or have any
other questions about their fitness to fly.

8.32 Another source of information for passengers
is the airlines themselves. The material most obviously targeted
at passengers is in airlines' in-flight magazines (p 124), although
it is open to question how many passengers read the health-related
articles they may contain other than by chance. We noted that
the half-page guide to "good health for travellers"
in the May 2000 edition of British Airway's in-flight magazine
High Life was about three-quarters of the way through its
200 pages. The guide contained advice on exercise to avoid "blood
circulation from becoming sluggish, something which can happen
if you sit still for a long period, which might cause circulatory
problems for some people". However, all this was accompanied
by a stern warning that a doctor should be consulted before starting
the exercise programme and that, by participating in it, passengers
released the airline from any responsibility for any health consequences
that might arise as a result.

8.33 British Airways have recently introduced a pre-flight
travel guide, Fly, that is issued with their tickets (Q
319). While the Summer 2000 edition we saw made no reference to
in-flight health, British Airways confirmed during the evidence
session (Q 325) and in later correspondence that they planned
to include appropriate material within it, alongside the development
of health-related information on their web site[106].
We understand that other aviation organisations are also developing
the provision of flight health information over the Internet.

8.36 In our recent Report
Science and Society[108],
we commented extensively on the role of the press and other media
in informing and educating the public on scientific matters, and
of the need for them to act responsibly in presenting sometimes
complex questions of uncertainty and risk. All those points apply
in the handling of information about the health effects of flying,
and we again commend to journalists the guidance outlined in Chapter
7 of Science and Society.

8.37 It is entirely possible to deal with aviation
health in a balanced way that develops awareness, knowledge and
understanding of the complicated and potentially emotive questions
that arise. For example, we commend a series of Consumers' Association
reports recently published in Holiday Which? namely In-flight
medical emergencies (January 1996); Health in the air (Winter
1999); and Are you sitting comfortably? (Spring 2000).
Journalism is not always so balanced. In Box 6 are some sample
headlines of articles published during our Inquiry. We understand
the importance of a headline in gaining the reader's attention
and, as noted, some of these do so in a reasonable manner. The
others seem to us to be arguably sensational.

8.39 During examination, Mr Kahn said that he was
not a doctor or scientist, but was an interested observer, medical
writer and journalist (QQ 109, 113 & 147). He claimed to be
a medical expert "by accretion" (Q 109), but his expertise
is limited. As Dr Giangrande noted (p 234), the view half-attributed
to him by Mr Kahn that "when you breathe in and out you are
not replenishing your blood plasma" (QQ 108 & 109) is
nonsense. This carelessness with facts is not limited to medical
or technical points. Mr Kahn's paraphrase of British Airways'
rejection of his request for research funding ("passenger
health is not a Board-approved priority theme" - Q 128) is
not the obvious intent of the letter[109].
These faults are continued in his journalism. Dr Perry stated
that Mr Kahn completely misreported two alleged cases of TB transmission
(p 267). Mr Scurr was surprised to find that Mr Kahn not only
claimed credit for DVT-related research that was not his but also
purported to summarise the findings which, at the time, were not
known (p 283). We acknowledge that some of the professionally
written material promulgated under the aegis of the Aviation Health
Institute is very helpful. However, we have been concerned at
the confused thinking, lack of substance and erroneous statements
in some of the other material presented to us and the public by
Mr Kahn, the Institute's founder director. In spite of his evident
enthusiasm for his cause, sadly we have not found him to be a
reliable source of scientific and medical information.